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Conferences and Medical Updates

Anticoagulations

Anticoagulation

Heparanoids : Heparin, Lovenox
Vit. K antagonist : Warfarin
Platelet inhibitor : Aspirin, clopidigril, prasugrel
Direct Thrombin Inhibitor : Dabigatran, argatroban
Direct Factor Xa inhibitors : Rivaroxaban, apixaban, edoxaban

Clinical uses of target-specific oral anticoagulants

Drugs Indications Dosing, timing, duration Monitoring Precautions
Dabigatran etexilate (Pradaxa®) Stroke and systemic embolism prophylaxis in non-valvular AF CrCl >30 mL/min: 150 mg twice daily No specific assay available Bioprosthetic heart valves
P-gp inducers and inhibitors
CrCl 15–30 mL/min: 75 mg twice daily
Rivaroxaban (Xarelto®) Stroke prophylaxis in non-valvular AF CrCl >50 mL/min: 20 mg once daily with the evening meal No specific assay available Spinal/epidural anesthesia or puncture
CrCl <15 mL/min in non-valvular AF
CrCl <30 mL/min in treatment or prevention of DVT, PE
P-gp inducers or inhibitors
CYP3A4 inducers or inhibitors
Pregnancy
CrCl 15–50 mL/min: 15 mg once daily with the evening meal
Treatment of DVT or PE 15 mg twice daily with food for 21 days then 20 mg daily with food for remaining treatment
DVT or PE secondary prophylaxis 20 mg once daily with food
DVT prophylaxis following hip or knee replacement surgery 10 mg once daily for 35 days (hip replacement) or 12 days (knee replacement)
Apixaban (Eliqiuis®) Stroke and systemic embolism prophylaxis in non-valvular AF 5 mg twice daily or 2.5 mg twice daily in patients with at least two of: age >80 years, body weight <60 kg, serum creatinine <1.5 mg/dL No specific assay available

CrCl creatinine clearance, DVT deep vein thrombosis, PE pulmonary embolism

Ok to do procedure when INR is less than 1.5
6.    Warfarin effect is reversed in 93% of cases after stopping 5 days
7.    SQ heparin 24 hours hold and IV heparin 6 hours
8.    Pradaxa (dabigatran), direct thrombin inhibitor, with normal Cr hold for 1-2 days and if Cr clearance is less than 50, then 3-5 days.
9.    Xaralto (rivaroxoban) 1 day for normal Cr, 2 days for GFR between 60-90 GFR3 days for 30 to 60 GFR and less than 15 to 30 4 days hold.
10.    Eloquis hold for 1, 3 and 5 days for normal GFR, above 50 and 30-50 GFR
11.    Aspirin 7-10 days.
12.    Plavix is 5 days, Ticlopidine is 7-10 days
13.    New NOAC have half life of 9-17 hours
14.    All NOAC are renaly excreted.
15.    Reverse NOAC – Novoseven (factor 7) or PCC (K centra)
16.    Pradaxa can be dialysed.
17.    Give oral charcoal if patient got NOAC within 2 hours.  Also give oral prep to flush out NOAC.
18.    Dabigatran can cause GERD and bloating.